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Open Access Highly Accessed Case report

Severe community onset healthcare-associated Clostridium difficile infection complicated by carbapenemase producing Klebsiella pneumoniae bloodstream infection

Simone Giuliano1, Maurizio Guastalegname1, Miryam Jenco2, Andrea Morelli3, Marco Falcone1 and Mario Venditti1*

Author Affiliations

1 Department of Public Health and Infectious Diseases Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy

2 Department of Anesthesiology and Intensive Care, “Villa San Pietro-Fatebenefratelli” Hospital, Rome, Italy

3 Department of Anesthesiology and Intensive Care, “Sapienza” University of Rome, Rome, Italy

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BMC Infectious Diseases 2014, 14:475  doi:10.1186/1471-2334-14-475

Published: 1 September 2014

Abstract

Background

Clostridium difficile infection (CDI) and Klebsiella pneumoniae carbapenemase producing-Klebsiella pneumoniae (KPC-Kp) bloodstream infection (BSI) are emerging health-care associated (HCA) diseases of public health concern, in terms of morbidity, mortality, and insufficient response to antibiotic therapy. Both agents can be acquired in the hospital but clinical disease can develop in a community setting, after discharge. We report here a putative link between the above-mentioned healthcare associated infections that appeared as a dramatic community onset disease with a fulminant fatal outcome.

Case presentation

We describe the case of a 63 year old man affected by severe CDI. Even though the patient underwent 72 hours of standard CDI antibiotic treatment, the clinical course was complicated by toxic megacolon and KPC-Kp BSI. The patient died 24 hours after total colectomy.

Conclusion

The impact of HCA-BSIs in complicating CDI is still unknown. Intestinal inflammatory injury and disruption of intestinal flora by standard antibiotic treatment could be responsible for promoting difficult-to-treat infections in CDI. By preserving intestinal flora, Fidaxomicin could have a crucial role in preventing BSIs complicating severe CDI.

Keywords:
Clostridium difficile; Klebsiella pneumoniae; KPC; Bloodstream infections; Intestinal flora; Fidaxomicin